Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Neutropenia is relatively common in patients with rheumatic diseases. Neutropenia is characterized by an absolute neutrophil count (ANC) of less than 1,500/µL. It is associated with diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) or it may be caused by the side effects of medications or accompanying infection. The risk of neutropenia-related infection increases with an ANC near 1,000/µL (moderate neutropenia) and rises dramatically as ANC falls below 500/µL (severe). Some patients with neutropenia require hospitalization in an isolation ward and are administered recombinant human granulocyte colony stimulating factor (rhG-CSF) or antibiotics to treat neutropenic fever. Our aim was to investigate the possible causes and clinical characteristics of severe neutropenia in Korean patients with rheumatic diseases.
Methods: The study participants (n=64) were enrolled from September 2003 to August 2013 from a population of patients with rheumatic diseases who were admitted to a tertiary care center. These subjects had severe neutropenia and received rhG-CSF at least once during hospitalization. We retrospectively examined data of the subjects including age, gender, initial diagnosis, concomitant medications, serial complete blood count, and bone marrow biopsy.
Results: The most frequent initial diagnoses were SLE (n = 35; 55%), RA (n = 13; 20%), and inflammatory myositis (n = 6; 9%). The possible causes of severe neutropenia were therapeutic drugs (n = 31; 48%), association with lupus (n = 17; 27%), infection (n= 12; 19%), and hemophagocytic syndrome (n = 4; 6%). During hospitalization, nine deaths occurred (14%, 9/64). Mortality was higher in patients with sepsis than in patients with neutropenia associated with other causes (Table). Pneumonia was the most common cause of sepsis in patients with neutropenia (58.3%, 7/12). The frequency of sepsis and death was higher in the long-term recovery group (≥ 28 days) than in the other groups (< 7 days and 7-27 days).
|
Possible cause |
Drug Toxicity (n = 31) |
Disease activity of SLE (n = 17) |
Sepsis (n = 12) |
P – value |
|
Age (yrs, Mean±SD) |
41.7 ± 17.4 |
28.6 ± 8.8 |
50.1±15.3 |
0.001 |
|
Women, no. (%) |
24 (77.4) |
15 (88.2) |
10 (83.3) |
0.647 |
|
Disease duration (yrs, Mean±SD) |
7.7 ± 8.8 |
4.2 ± 3.7 |
9.7 ± 12.9 |
0.552 |
|
Any immunosuppressive drug |
23 (74.2) |
9 (52.9) |
9 (75.0) |
0.238 |
|
Leucocytes (Mean±SD, /µL) |
1258.1 ± 653.6 |
1117.6 ± 304.6 |
1058.3 ± 550.1 |
0.581 |
|
Hemoglobin (Mean±SD, g/dL) |
9.1 ± 2.2 |
9.6 ± 1.5 |
8.6 ± 1.5 |
0.401 |
|
Platelets (Mean±SD, X 103/µL) |
118.9 ± 82.5 |
132.9 ± 77.4 |
115.9 ± 70.7 |
0.688 |
|
Neutrophils (Mean±SD, /µL) |
262.9 ± 462.7 |
376.2 ± 313.0 |
366.3 ± 471.1 |
0.301 |
|
Pancytopenia, no. (%) |
22 (71.0) |
11 (64.7) |
9 (75.0) |
0.828 |
|
Recovery time of neutropenia |
5.3 ± 5.3 |
8.1 ± 13.9 |
19.3 ± 37.1 |
0.515 |
|
Death, no. (%) |
4 (10.5) |
1 (5.6) |
4 (50) |
0.033 |
Conclusion: In patients with rheumatic diseases, drug toxicity was the most common cause of severe neutropenia. Among the causes of neutropenia, sepsis is of greatest concern; therefore, physicians need to pay attention to the early detection of infection.
Disclosure:
C. N. Son,
None;
J. M. Kim,
None;
S. H. Kim,
None;
S. K. Cho,
None;
Y. K. Sung,
None;
T. H. Kim,
None;
J. B. Jun,
None;
S. C. Bae,
None;
D. H. Yoo,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/severe-neutropenia-in-patients-with-rheumatic-diseases-at-a-tertiary-care-hospital-in-south-korea/